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Health Issues  Diabetes: affects 200,000 people - only half of them diagnosed – 3 x more prevalent in Māori and Pacific  Cardiovascular disease: 40% of all deaths - burden greatest among Māori and Pacific  Cancer: next leading cause of death – significantly worse outcomes for Māori and Pacific  Mental health: 21% have had a mental disorder in the past 12 months – worse for Māori and Pacific  Smoking: 5,000 deaths this year

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Private Involvement Protocols  First and foremost, a direct benefit to publicly-funded patients/people with disabilities  Spare capacity  Patients to be advised of publicly-funded options  If DHB staff involved, needs to be within range of current services  Public disclosure  Conflict of interest provisions

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The protocols have… Been challenged and modified Are they… Right? Well understood? Being applied?

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But also common ground…. We all need energy. But are we consuming too much for our lifestyles? Someone once said that being overweight was “a normal response to an abnormal environment”. In today’s busy world…. Killer - Joules: the calorie curse

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Areas to work on Clarity of scope of services funded Common understanding of protocols Workforce Recruitment & retention Use flexibly Training Develop new roles Remuneration – form (incentives) and level (costs) Management of dual practice Equity and access issues Effect on demand